What’s the Difference Between Propecia and Rogaine?

Battling male pattern hair loss? There are medications that can help slow hair loss and even regrow some of the hair you've lost.
Battling male pattern hair loss? There are medications that can help slow hair loss and even regrow some of the hair you’ve lost.

Propecia and Rogaine — the two brand-name medications approved for the treatment of male pattern hair loss — work in very different ways. However, the two drugs do share at least one major characteristic in common.

The active ingredients in both of these drugs — finasteride in Propecia and minoxidil in Rogaine — were originally marketed to treat conditions that have nothing to do with hair loss. Their potential for the treatment of hair loss was discovered somewhat serendipitously.

Was Used to Treat Prostate

Finasteride, first marketed in 5-milligram tablets as Proscar, was originally approved by the Food and Drug Administration to treat benign prostatic hyperplasia, a noncancerous enlargement of the prostate gland. However, men taking Proscar during early clinical trials experience unexpected hair growth.

Intrigued by this interesting side effect, Merck & Company, Proscar’s manufacturer, decided to investigate the possibility of marketing a lower-strength version of finasteride as an oral medication to treat hair loss. In 1998, the FDA gave Merck the go-ahead to market Propecia, a 1-milligram tablet of finasteride, to combat hair loss.

High Blood Pressure Drug

Minoxidil, the active ingredient in Rogaine, was originally marketed as Loniten, an oral medication designed to treat high blood pressure. Here, too, unexpected hair growth — sometimes in such inappropriate places as the forehead and cheeks — was reported by a number of patients taking the anti-hypertensive medication.

After further study and lengthy clinical trials, Upjohn & Company in the late 1980s won FDA approval to market a 5 percent minoxidil topical solution to help slow hair loss and promote hair regrowth among those who had experienced extensive hair loss. Still later, Upjohn introduced a 2 percent minoxidil topical solution designed for use by women who are fighting hair loss.

Drugs Work Differently

As previously noted, Propecia and Rogaine work in very different ways to combat hair loss. Propecia, which is taken orally, works at the hormonal level, and Rogaine is a topical medication applied directly to affected areas of the scalp.

Propecia inhibits 5-alpha reductase, an enzyme that promotes the conversion of testosterone into a potent androgen known as dihydrotestosterone, or DHT.

Most hair loss can be traced to gradual miniaturization of hair follicles.
Most hair loss can be traced to gradual miniaturization of hair follicles.

DHT targets the hair follicle, gradually shrinking it in a process that leads eventually to baldness. Studies have shown that men who take Propecia daily reduce scalp levels of the androgen by as much as 60 percent.

Hair Follicle Miniaturization

In the end, most hair loss can be traced to the miniaturization of hair follicles, a process that can be staved off or even reversed hormonally by taking Propecia. Although its precise mechanism of operation is unknown, topical Rogaine works directly at the hair follicle level, slowing or reducing the miniaturization process and slightly enlarging the follicles themselves.

In a head-to-head (pun fully intended) comparison of Propecia and Rogaine, the American Hair Loss Association, comes down solidly in favor of the former as “the first line of attack for all men interested in treating their male pattern baldness.” Propecia’s ability to sharply lower DHT levels “is the only truly effective, medically proven way to arrest the hair loss process,” declares AHLA.

Positive Results Cited

In support of its recommendation of Propecia over Rogaine, AHLA cites evidence from clinical trials showing that 86 percent of the men taking the drug were able to stop the progression of hair loss. And 65 percent of participants in the clinical trials experienced a significant increase in hair growth, according to the association.

Although it clearly favors Propecia as the most effective treatment for hair loss, AHLA says there’s still room for Rogaine to play an active role in the fight against receding hairlines. In particular, the California-based organization says Rogaine may be useful as an adjunct to Propecia or as a replacement for Propecia in patients who’ve failed to get satisfactory results from that drug. For women, Rogaine is the only game in town since the hormonal effects of Propecia make it inappropriate for use by women.

Propecia and Rogaine share another important characteristic in common. Both drugs are effective against hair loss only so long as they continue to be used on a daily basis. Stop treatment with either of the medications, and whatever positive results you’ve achieved will likely soon disappear.

Common Side Effects

Like most prescription medications, both Propecia and Rogaine have side effects. Although most side effects are mild and disappear after continued use of the drug, contact your doctor if either drug’s side effects persist.

According to Drugs.com, Propecia’s most common side effects include chills, cold sweats, confusion, and dizziness or lightheadedness when getting up from a seated or prone position. Other side effects that are less common but have been observed include bloating or swelling of the face, arms, hands, lower legs or feet; breast enlargement and/or tenderness; hives or welts; itchy skin; rapid weight gain; skin rash; and tingling of the hands or feet.

Sexual Side Effects

Of greater concern for Propecia users, the drug has caused infertility and sexual side effects in a very small percentage of the men using it, according to WebMD.com. Between 1998 and 2011, the FDA investigated 421 reports of sexual dysfunction. In 59 of these cases, the sexual dysfunction persisted for several months after use of the drug was discontinued.

If you don't already have a prescription for Propecia or generic finasteride, eDrugstore can arrange an online consultation with one of its licensed doctors for no additional cost.
If you don’t already have a prescription for Propecia or generic finasteride, eDrugstore can arrange an online consultation with one of its licensed doctors for no additional cost.

Despite the relatively rare incidence of these sexual side effects, FDA now requires the drugmaker to advise users of these potential adverse effects in new labels warning that Propecia may cause loss of sexual desire, inability to ejaculate, and inability to reach orgasm.

Minimal Side Effects

Rogaine’s side effects are fairly minimal, according to Drugs.com. Itching and/or skin rash has been reported by some users of the drug. Among other side effects that are even less common but have been reported by users are acne at the site of application, burning of the scalp, facial hair growth, increased hair loss, inflammation or soreness at the hair root, reddened skin, and facial swelling.

Rogaine for Women, which contains a lower concentration — 2 percent — of minoxidil, also has few side effects. Among the more common is a dry, itchy scalp and/or irritation at the application site. In rare cases, women using the product have experienced the growth of facial hair. Rogaine has had no reports of interactions with other medications, but it does advise against using Rogaine for Women while also applying other topical solutions to the scalp.

Generic Finasteride

With the introduction of a generic 1-milligram finasteride tablet, users of Propecia now have an alternative. While there is no essential difference between the two drugs in terms of how they act, the generic version of finasteride is cheaper than Propecia, and over time the price gap between the two is almost certain to widen.

Whether you’re looking to buy Propecia or its generic alternative, eDrugstore.com offers a convenient way to order both of these drugs online. If you have a prescription from your family doctor, you can fax it or scan and email it along with your order. If you have no prescription, eDrugstore can set up a free online consultation with one of the licensed physicians on its team. All drugs shipped from eDrugstore are FDA approved and are sourced through licensed U.S. pharmacies.

Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.

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